Provider Demographics
NPI:1801449756
Name:COLLINS, MALLORY MORRIS (OD)
Entity type:Individual
Prefix:DR
First Name:MALLORY
Middle Name:MORRIS
Last Name:COLLINS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MALLORY
Other - Middle Name:NICOLE
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:325 W LEE DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-1912
Mailing Address - Country:US
Mailing Address - Phone:662-627-2887
Mailing Address - Fax:662-495-4082
Practice Address - Street 1:325 W LEE DR
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-1912
Practice Address - Country:US
Practice Address - Phone:662-627-2887
Practice Address - Fax:662-495-4082
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS990152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist